Rates of Disease Progression by Baseline CD4 Cell Count and Viral Load After Initiating Triple-Drug Therapy

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Abstract
Triple-drug combination antiretroviral therapy has been shown to dramatically decrease morbidity and mortality in symptomatic and asymptomatic human immunodeficiency virus type 1 (HIV) infected individuals.1-3 As a result, triple-drug regimens have been widely adopted for the treatment of HIV infection starting in 1996.4-6 Recommendations for the initiation of antiretroviral therapy are largely based on CD4 T lymphocyte cell count and plasma HIV RNA levels. These thresholds have been selected based on the risk for disease progression in natural history and observational studies as well as randomized clinical trials.7-12 Rates of disease progression to acquired immunodeficiency syndrome (AIDS) or death for such thresholds in treated patients, however, have not been fully characterized. We, therefore, undertook our analysis in an attempt to characterize the rates of disease progression to AIDS or death as a function of baseline CD4 cell counts and HIV RNA levels in a population-based cohort of HIV-infected individuals initiating triple-drug antiretroviral therapy regimens. We further sought to identify a possible threshold at which the short-term clinical benefit derived from triple-drug regimens became compromised.